Abstract
Objective
This retrospective study assessed long-term clinical outcome in a series of patients undergoing anterior cervical discectomy (ACD) for treatment of myeloradiculopathy secondary to one- to two-level cervical discoarthrosis. To verify concerns about long-term adverse clinical effects following ACD, a review of literature on the topic was also made.
Methods
The clinical course and long-term outcome of 125 consecutive patients with cervical myeloradiculopathy operated on by ACD 5 to 19 years ago (mean, 11.3 years) were reviewed. Seventy-four patients (59%) showed a clinical picture of pure radiculopathy, and 51 patients (41%) had myeloradiculopathy. Long-term clinical outcome and Visual Analog Scale (VAS) scores for neck and arm pain were recently assessed and compared with post-surgical status. Clinical outcome was graded according to the criteria of Odom et al. (JAMA 166:23–28, 36). The survey of the literature on long-term clinical outcome after ACD was internet-based.
Results
Long-term clinical outcome was excellent in 61% of patients, good in 26%, satisfactory in 9% and poor in 4%. The same figures at the time of discharge were 65%, 29%, 6% and 0%, respectively. Mean long-term neck and arm pain VAS scores were 2.5 and 0.8, respectively, while postoperatively, the same values were 2.1 and 0.5. Additional discectomy at an adjacent level was performed in five patients 10 months to 8 years after the first operation.
Conclusions
In our series, 96% of patients had a sustained favourable long-term clinical outcome after ACD. These favourable results confirm data in the literature and support our preference for ACD as the simplest, fastest and cheapest surgical option for treating myeloradiculopathy secondary to one- to two-level cervical discoarthrosis.
Similar content being viewed by others
References
Abd-Alrahman N, Dokmak AS, Abou-Madawi A (1999) Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir (Wien) 141:1089–1092
Alvarez JA, Hardy RW Jr (1999) Anterior cervical discectomy for one-and two-level cervical disc disease: the controversy surrounding the question of whether to fuse, plate, or both. Crit Rev Neurosurg 9:234–251
Barlocher CB, Barth A, Krauss JK, Binggeli R, Seiler RW (2002) Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg Focus 12(1):E4
Bartels RHMA (2009) Evidence-based medicine: a marketing tool in spinal surgery. Neurosurgery 64:11–13
Bartolomei JC, Theodore N, Sonntag VKH (2005) Adjacent level degeneration after anterior cervical fusion: a clinical review. Neurosurg Clin N Am 16:575–587
Bertalanffy H, Eggert HR (1988) Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases. Acta Neurochir (Wien) 99:127–135
Bollati A, Galli G, Gandolfini M, Marini G, Gatta G (1983) Microsurgical anterior cervical disk removal without interbody fusion. Surg Neurol 19:329–333
Cuatico W (1981) Anterior cervical discectomy without interbody fusion: an analysis of 81 cases. Acta Neurochir (Wien) 57:269–274
Dan NG (1998) Anterior cervical graftless fusion for soft disc protrusion. A review of 509 disc excisions in 476 patients. J Clin Neurosci 5:172–177
Donaldson JV, Nelson PB (2005) Anterior cervical discectomy without interbody fusion. Surg Neurol 57:219–225
Dowd GC, Wirth FP (1999) Anterior cervical discectomy: is fusion necessary? J Neurosurg Spine 1:8–12
Dunsker SB (1994) Comment to Murphy MA, Trimble MB, Piedmonte MR, Kalfas IH: Changes in the cervical foraminal area after anterior discectomy with and without a graft. Neurosurgery 34:96
Feiz-Erfan I, Klopfenstein JD, Bambakidis NC, Sonntag VKH (2005) Surgical management of cervical disc disease: from no fusion to fusion and back again. Clin Neurosurg 52:331–337
Gaetani P, Pancioni F, Spanu G, Rodriguez Y, Baena R (1995) Anterior cervical discectomy: an analysis on clinical long-term results in 153 cases. J Neurosurg Sc 39:211–218
Grisoli F, Graziani N, Fabrizi AP, Peragut JC, Vincentelli F, Diaz-Vasquez P (1989) Anterior discectomy without fusion for treatment of cervical lateral soft disc extrusion: a follow-up of 120 cases. Neurosurgery 24:853–859
Haden N, Latimer M, Seeley HM, Laing RJ (2005) Loss of intervertebral disc height after anterior cervical discectomy. Br J Neurosurg 19:469–474
Hankinson H, Wilson C (1975) Use of the operating microscope in anterior cervical discectomy without fusion. J Neurosurg 43:452–456
Hauerberg J, Kosteljanez M, Boge-Rasmussen T, Dons K, Gideon P, Springborg JB et al (2008) Anterior cervical discectomy with or without fusion with ray titanium cage; a prospective randomized clinical study. Spine 33:458–464
Hilibrand AS, CarlsonGD PMA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Jt Surg Am 81:519–528
Hirsch C (1960) Cervical disc rupture: diagnosis and therapy. Acta Orthop Scand 30:172–186
Husag L, Costabile G, Vanloffeld W, Keller RJD, Landolt H (1997) Anterior cervical discectomy without fusion: a comparison with Cloward's procedure. J Clin Neurosci 4:331–340
Husag L, Probst Ch (1984) Microsurgical anterior approach to cervical discs. review of 60 consecutive cases of discectomy without fusion. Acta Neurochir (Wien) 73:229–242
Irwin ZN, Hilibrand A, Gustavel M, McLain R, Shafer W et al (2005) Variation in surgical decision making for degenerative spinal disorders. Part II: cervical spine. Spine 30:2214–2219
Jacobs WCH, Anderson PG, Van Limbeek J, Willems PC, Pavlov P (2004) Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev 4:CD 004958
Katsuura A, Hukuda S, Saruhashi Y, Mori K (2001) Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:320–324
Klaiber RD, von Ammon K, Sarioglu AC (1992) Anterior microsurgical approach for degenerative cervical disc disease. Acta Neurochir (Wien) 114:36–42
Konduru S, Findlay G (2009) Anterior cervical discectomy: to graft or not to graft? Br J Neurosurg 23:99–103
Laus M, Pignatti G, Alfonso C, Martelli C, Giunti A (1992) Anterior surgery for the treatment of soft cervical disc herniation. Chir Org Mov 77:101–109
Lunsford LD, BissonetteDJ JPJ, Sheptak PE, Zorub DS (1980) Anterior surgery for cervical disc disease. Part I: treatment of lateral cervical disc herniation in 253 cases. J Neurosurg 53:1–11
Martins AN (1976) Anterior cervical discectomy with and without interbody bone graft. J Neurosurg 44:290–295
Maurice-Williams RS, Elsmore A (1999) Extended anterior cervical decompression without fusion: a long-term follow-up study. Br J Neurosurg 13:474–479
McCormick PC (2007) The adjacent segment. J Neurosurg Spine 6:1–4
Murphy MG, Gado M (1972) Anterior cervical discectomy without interbody bone graft. J Neurosurg 37:71–74
Murphy MA, Trimble MB, Piedmonte MR, Kalfas IH (1994) Changes in the cervical foraminal area after anterior discectomy with and without a graft. Neurosurgery 34:93–96
Nandoe Tewarie RDS, Bartels RHMA, Peul WC (2007) Long-term outcome after anterior cervical discectomy without fusion. Eur Spine J 16:1411–1416
Odom GL, Finney W, Woodhall B (1958) Cervical disc lesions. JAMA 166:23–28
Oktenoglu T, Cosar M, Ozer AF, Iplikcioglu C, Sasani M, Cambulat N et al (2007) Anterior cervical microdiscectomy with or without fusion. J Spinal Disord Tech 20:361–368
Rao PJ, Christie JG, Ghareman A, Cartwright CA, Ferch RD (2008) Clinical and functional outcomes of anterior cervical discectomy without fusion. J Clin Neurosci 15:1354–1359
Robertson JT, Johnson SD (1980) Anterior discectomy without fusion: long-term results. Clin Neurosurg 27:440–449
Rosenorn J, Hansen EB, Rosenorn MA (1983) Anterior cervical discectomy with and without fusion. J Neurosurg 59:252–255
Savoilainen S, Rinne J, Hernesniemi J (1998) A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery 43:51–55
Sonntag VKH, Klara P (1996) Controversy in spine care. Is fusion necessary after anterior cervical discectomy? Spine 21:1111–1113
Tegos S, Rizos K, Papathanasiu A, Kyriakopulos K (1994) Results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. Eur Spine J 3:62–65
Thorel W, Cooper J, Hellbusch L, Leibrock L (1998) The long term clinical outcome of patients undergoing anterior cervical discectomy with and without intervertebral bone graft placement. Neurosurgery 43:268–274
Ulivieri S, Petrini C, Palma L, Oliveri G (2007) Anterior cervical discectomy with interbody fusion: analysis and considerations of a series of 100 cases. Minerva Ortop Traumatol 58:343–346
van den Bent MJ, Oosting J, Wouda EJ, van Acker REH, Ansink BJJ, Braakman R (1996) Anterior cervical discectomy with or without fusion with acrylate: a randomized trial. Spine 21:834–839
Watters WC III, Levinthal R (1994) Anterior cervical discectomy with and without fusion: results, complications and long-term follow-up. Spine 19:2243–2247
Wilson DH, Campbell DD (1977) Anterior cervical discectomy without bone graft. J Neurosurg 35:551–555
Wirth FP, Dowd GC, Sanders H, Wirth C (2000) Cervical discectomy. A prospective analysis of three operative techniques. Surg Neurol 53:340–348
Xie J, Hulbert RJ (2007) Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study. Neurosurgery 61:107–117
Yamamoto I, Ikeda A, Shibuya N, Tsugane R, Sato O (1991) Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease. Spine 16:272–279
Acknowledgment
The authors are indebted to Dr. Francesco Natrella for his technical assistance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Palma, L., Mariottini, A., Carangelo, B. et al. Favourable long-term clinical outcome after anterior cervical discectomy. A study on a series of 125 patients undergoing surgery a mean of 11 years earlier. Acta Neurochir 152, 1145–1152 (2010). https://doi.org/10.1007/s00701-010-0650-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-010-0650-5